TriWest continues to receive questions regarding the certification requirements for behavioral health programs and facilities. There are different levels of certification and they are explained below.
Inpatient facilities for behavioral health must apply for TRICARE certification through Wisconsin Physician Services' (WPS) provider certification unit. In order to be considered for TRICARE certification, the facility must be accredited by the Joint Commission on Accreditation of Hospitals Organizations (JCAHO.) WPS processes the application and will determine if the facility meets certification requirements.
A facility may become "network" by contracting with TriWest or their network subcontractors. The TriWest contract requires 96% utilization of "network" facilities and providers.
Mental Health Partial Hospitalization Programs (MH-PHP), Residential Treatment Facilities (RTC), and Substance Use Disorder Rehabilitation Facilities (SUDRF) must be certified separately by Maximus, the National Quality Monitoring Contractor (NQMC). If a facility wishes to become certified, they need to contact Maximus and a packet will be sent to the facility for completion. The Maximus contact is Beth Friedman at (602)308-7178. Once Maximus receives the application, they will determine eligibility based on review of the packet and site visits. Once approved by Maximus, the facility will be contracted by TriWest or the Network Subcontractors in order to become a "network" facility.
Chemical Dependency Partial Hospitalization Programs (CD-PHP) do not require certification by Maximus provided that they are a part of a TRICARE certified hospital based program. Inpatient chemical dependency services are typically provided by TRICARE certified hospital based programs that offer these services as an additional specialty. A SUDRF is a stand alone facility that provides only Chemical Dependency services. These facilities must be certified by Maximus. Currently there are 4 SUDRF facilities in the West Region.
Additionally, to be considered network, providers need to complete the credentialing process of the network subcontractor, which includes verification that the facility is certified by Maximus.
Posted 03/04/2005